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Change management for more equitable care and health


A medium-sized Swedish county council wanted to create an understanding among politicians and civil servants of equality of care and health in the county. Sirona was given the assignment of carrying out change work in order to develop an action plan to halt negative development and counteract health and care related inequalities within the county.

The challenge

The challenge was to work with the county council to develop an action package to reverse the trend of increasing inequality, through measures including an integrated health programme. With this as a basis, a platform was to be created to change the way in which the county council worked with equality of care and health.


The first part of the assignment focused on implementing an extensive inventory and situational analysis of the development of health and medical related inequalities in the county. This included highlighting and investigating differences in socio-economic, gender and psychiatric aspects, together with the range of healthcare in the form of access and availability between different municipalities in the county within different illness groups. During this, interviews were conducted with people including representatives for a number of municipalities and county politicians in order to create wider understanding of the problem and to anchor change on the basis of the approach and method presented during the change process. The situational analysis was based on both public data (SCB, Socialstyrelsen, quality registers, Open Comparisons etc.) and internal healthcare data. For healthcare data, a comparison was also carried out between this and other county councils in Sweden.

In the second part of the assignment, Sirona's team carried out health and economic analyses for selected and relevant patient groups. The health and economic analyses identified heart failure patients and women smoking while pregnant as groups requiring prioritisation in the change process. A model and methodology was developed with these groups to enable working with an integrated health programme as part of the change process. Action programmes were developed for these groups in close collaboration with representatives of primary care and upper management.


The assignment resulted in a shared picture and understanding among politicians and civil servants regarding the significance of working more systematically with equality of care and health. The assignment provided an in-depth, fact-based picture of inequalities in care and health in terms of aspects such as age, gender and educational level. The end product was a number of concrete recommendations and measures intended to create the conditions for an extended change process and to develop and implement increasingly knowledge-based care which would ultimately contribute to increased equality.

One effect of the project was that the Swedish Association of Local Authorities and Regions (SKL) highlighted the county council as a role model for work with equality of care and health. SKL also chose to enter into collaboration with Sirona and three other county councils to implement additional activities to motivate overall changes in the public health area.